Cannabis for Nausea and Vomiting

Published on October 6, 2015, By Gooey Rabinski

Cannabis has proven to be very effective at improving three primary adverse conditions in the human body: 1) Inflammation, 2) pain, and 3) nausea, vomiting, and lack of appetite. Because it’s really more complicated than this, but easy takeaways make for effective education, nausea and vomiting will be categorized with appetite stimulation. They are part of the same mechanism that is governed by the body’s endocannabinoid system, which is supplemented by cannabinoids from outside sources like marijuana.

Patients suffering from cancer and HIV/AIDS, who must undergo chemotherapy and radiation therapy, frequently suffer from loss of appetite, nausea, and vomiting. The image of a doubled over, retching chemotherapy or AIDS patient has been seared into the consciousness of most Americans, many of whom might employ smoked or vaped cannabis as an anti-emetic (nausea treatment) for an ulcer, upset stomach, or in dealing with the negative side effects of a variety of pharmaceutical drugs and therapies.

Because a particular strain of cannabis necessarily contains a unique blend of up to more than 100 types of cannabinoids and 200 terpenes, the argument of the efficacy of cannabis for nausea and vomiting isn’t as simple as this health-bearing herb being or not being good for these common symptoms. Overall, cannabis is very good for treating nausea, which may be caused by motion sickness, meningitis, intense pain, food poisoning, overeating, appendicitis, and even a brain tumor.

However, different strains of cannabis offer markedly different medicinal efficacy. For example, Durban Poison, a 100 percent landrace sativa from the Rift Valley in Africa, is especially effective at reducing or eliminating nausea, headaches, and pain. [For more cannabis strains that have proven effective for treating nausea and vomiting, see the list at the end of this article.]

Cannabis and Appetite

Patients suffering from nausea and vomiting, regardless of reason, obviously don’t have an appetite. Therefore, the significant ability of many strains of cannabis to develop appetite in conditions where it otherwise does not exist, such as anorexia, cancer, severe and chronic pain, AIDS, and Crohn’s, necessarily means that it is also very effective at reducing or eliminating nausea and vomiting.

Cannabis is a powerful appetite stimulant. One of the ages-long memes associated with marijuana is the onset of severe hunger (“the munchies”), with Hollywood chronically creating scenes involving stereotypical pot-smoking college students scarfing down bags of Doritos and Oreos.

Dr. Donald Abrams, a professor of clinical medicine at the University of California and medical cannabis advocate, wrote in 2011 in response to a study that showed that a synthetic form of THC, one of the major therapeutic cannabinoids and the source of pot’s psychoactive symptoms, was effective in stimulating appetite in cancer patients:

“I don’t think there’s anything startling about the fact that cannabis or cannabinoids increases the appetite. That’s been well known for years.”

Dr. Lester Grinspoon and Nausea

“I see it as kind of a wonder drug of our time,” said Harvard psychiatrist and emeritus professor Dr. Lester Grinspoon during an interview. Grinspoon, author of Marijuana Reconsidered (1971) and Marihuana: The Forbidden Medicine(1993; it has been translated into 14 languages) and a noted authority on the effectiveness of cannabis for a wide range of ailments, is intimately familiar with the efficacy of this herb for nausea and vomiting, especially when these symptoms are the side effects of chemotherapy intended to fight cancer.

Grinspoon’s son, Danny, was diagnosed with childhood leukemia in 1967 (the year, coincidentally, when Grinspoon began investigating cannabis), when he was 10. Shortly thereafter, the boy began chemotherapy. “The chemotherapeutics that he had to receive were just devastating to him in terms of the nausea and the vomiting,” said Grinspoon. He continued:

“It’s a nausea that goes right down to your toenails. It’s really beyond description.”

Despite having published Marijuana Reconsidered, Grinspoon, like most of society, was ignorant of the ability of cannabis to very effectively reduce or eliminate otherwise debilitating nausea. Students of Buddhism would call the next chapter in the story good karma, especially considering that Grinspoon probably collected more criticism than money for his progressive and controversial 1971 book. During a dinner party, an oncologist colleague who had read Marijuana Reconsidered informed Grinspoon of a 17-year-old leukemia patient who had effectively used cannabis to treat the nausea that resulted from his chemotherapy.

It was actually Grinspoon’s wife, Betty, who, when returning from a chemotherapy session with their son, suggested that the couple obtain cannabis to deal with his nausea. Initially — and ironically, given his academic and advocacy reputation — Grinspoon shot down the idea based on the illegality of marijuana and any possible offense that might be perceived by their son’s physicians. “So I was against it,” reported Grinspoon. Despite her husband’s opposition to her idea, Mrs. Grinspoon obtained cannabis for her son at his high school parking lot from one of his friends.

After his wife shared cannabis with their son during the next chemotherapy session, Grinspoon noted that the boy was unusually relaxed, happy, and not in the least bit suffering from nausea. “Before, with this particular chemo, he became nauseous and felt awful right away,” said Grinspoon. He described how his son would normally require being rushed home to vomit “in bed, with a bucket at his side, until it was just dry heaves” for sometimes eight hours straight.

But on that day in 1972 when his wife first shared cannabis with their son, who was normally curled in a ball on the back seat of the family car, he asked if they could stop for a sandwich on the way home from the chemotherapy session. Grinspoon has described how his son was completely alleviated of the suffering of extreme nausea and vomiting due to chemotherapy — as long as he consumed cannabis prior to his therapy sessions. Said the Harvard professor:

“He never had any difficulty with nausea and vomiting with further [chemotherapy] treatments for as long as he lived. He was free of that anxiety…It was a godsend.”

Grinspoon has also focused on the issue of the anxiety that springs from the realization of a patient that cannabis is the only medication that is helpful to them, but that it is an illegal substance in most areas of the nation (and, federally speaking, in all areas of the U.S.). Reflecting on his son’s battle with the treatment-induced nausea associated with his leukemia, Grinspoon said:

“People who suffer from these symptoms and syndromes, depending on just how serious they are, that’s always accompanied by anxiety. And to take and artificially impose another level of anxiety, the anxiety involved in doing something which is illegal — for which you can be punished — is cruel.”

Indicas, Sativas, and Myrcene

It can accurately be argued that anti-nausea medication has evolved significantly since the early 1970s when Grinspoon made his very personal discovery about how powerfully cannabis combats nausea and vomiting. However, such pharmaceutical therapies are typically exotically expensive (much more so than cannabis, even in black markets) and carry their own negative side effects (or are ineffective for some patients). Cannabis, however, carries the side effects of appetite stimulation (admittedly not good for those suffering obesity) and possible slumber (but only with some indica strains).

Except for some cases of anorexia, which has a psychiatric root cause, most strains of cannabis almost universally cause humans and all mammals (because they all possess an endocannabinoid system) to develop hunger and an appetite, sometimes to the point of binge eating. Although more research is necessary in this area, studies have revealed that indica strains that contain a larger percentage of myrcene, a terpene that appears to determine whether a particular strain of cannabis is indica or sativa, may be especially effective at squelching nausea and generating appetite in patients.

Steep Hill Labs has gone on record stating that cannabis strains that contain very low amounts of myrcene (below 0.5 percent) are sativas, meaning they are more likely to curb appetite, counter to the popular stereotype that all marijuana causes the munchies. Strains of cannabis with more myrcene are categorized as indica and typically deliver symptoms that include appetite stimulation. A notable exception to this is pure sativa Durban Poison, which is good for defeating nausea, although not necessarily generating hunger. This may be due to a peculiar synergistic effect resulting from the delicate interaction of cannabinoids and terpenes, something called the entourage effect. According to the laboratory:

“If a sample has over 0.5% myrcene, it will have indica, or “couchlock” effects. If a sample has less than 0.5% myrcene, it will have the soaring sativa effect. It is simply the amount of myrcene that is in the sample that dictates how [one] will be affected.”

The Studies

A study published in 2013 in the British Journal of Pharmacology studies the effect of two important cannabinoids found in marijuana, THCV and CBDV, which were given to laboratory rodents to gauge their effect on toxin-induced nausea. According to the study’s author, both cannabinoids “may have therapeutic potential in reducing nausea.”

A review of the studies indicates that cannabis and, specifically, the cannabinoid THC are effective treatments for loss of appetite in cancer and HIV/AIDS patients. A 2002 study revealed that cannabis treatment helped a group of Alzheimer’s patients who had previously refused food to gain weight.

A study conducted by the Michigan Department of Health in 1982 involving cancer patients undergoing chemotherapy and seeking to alleviate nausea and vomiting involved 165 participants who were randomly placed into one of two control groups: Those using cannabis and those taking a pharmaceutical drug called Torecan. If the initial treatment was declared a failure, patients could elect to switch to the alternate therapy.

This unique research revealed that 90 percent of the patients who received cannabis desired to continue using it; only eight of 83 patients randomized to marijuana chose to discontinue and try Torecan. However, of the Torecan group, 22 of the 23 patients elected to discontinue its use and switch to cannabis. The study concluded that 71 percent of the patients who received cannabis reported no vomiting and only moderate nausea following chemotherapy treatment.

The study, when publishing “serious side effects” related to the use of cannabis, found the most common to be increased appetite, with 32 percent of patients reporting enhanced hunger.

In 1999, the Institute of Medicine in Washington, D.C. (a nonprofit organization founded in 1970 as part of the National Academy of Sciences) released a detailed report regarding medical cannabis. The report, an examination of 15 previous studies, concluded that “accumulated data indicate a potential therapeutic value for [cannabis] drugs, particularly for symptoms such as pain relief, control of nausea and vomiting, and appetite stimulation.”

It has been found that the body’s endocannabinoid system plays a major role in mediating hunger and stimulating appetite. A 2011 study published in the journal Biological Psychiatry found a link between anorexia nervosa and bulimia based on a brain malfunction that leads to a loss of endocannabinoids. Because the endocannabinoid system is known to regulate bodily functions such as hunger, this endocannabinoid deficiency results in a distortion of appetite.

The study concluded that the functionality of CB1 receptors in the brain and nervous system, which bind with THC, was reduced in the brains of women with anorexia. The study reported:

“The role of endocannabinoids in appetite control is clearly important. These new data point to important connections between this system and eating disorders.”

Patient Testimonials

“Chemo and radiation were horrible,” said cancer patient and Montana resident Point Hatfield. “I was throwing up almost all day long, every day. It zapped every ounce of life I had in me, just about. I was just hangin’ on by a thread.”

Hatfield’s oncologist pointed out how his patient had taken a variety of mainstream anti-nausea drugs in an effort to stave off this negative side effect of his cancer treatments. “I was on ativan, I was on zoloft, and there were a couple of steroids that I wore a patch with,” he said. Hatfield described how conventional pharmaceutical drugs of this type did nothing to alleviate the nausea he suffered as a result of his chemotherapy.

“They just did not work,” said Hatfield when describing the slew of pharmaceutical drugs he was prescribed to treat his nausea. When asked if such therapies had any efficacy for his condition, he responded, “Not at all. They didn’t alleviate anything.” It was at this point that Hatfield’s doctor recommended medical cannabis.

“After I got the medical marijuana, it just alleviated so much of that sick, pukey feeling and it alleviated the throwing up,” said Hatfield, emphasizing that he gained this efficacy immediately upon consumption of cannabis. He added, “It was a godsend. Throwing up all the time is not good.”

When asked how cannabis has helped him battle his disease, Hatfield responded:

“I believe that the medical marijuana saved my life. I couldn’t eat anything. I couldn’t swallow. I think it just saved my life.”

Five years following his initial diagnosis, Hatfield was given the green light and deemed cancer free. He benefits from the 2004 Montana Medical Marijuana Act, which permits him to possess, use, and even cultivate cannabis for his disease. “There’s a false stigma attached to [cannabis]. It’s our job to help other people, it’s our responsibility,” he said.

Edward Arthur, a New Hampshire resident whose wife contracted metastatic breast cancer in 1995, described how cannabis helped her deal with the extreme nausea experienced as part of her chemotherapy and other pharmaceutical drugs and treatments. “Cannabis has helped her to be able to feel less nauseous, have more appetite, and seems to help somewhat with the neuropathy she experiences from past treatments,” said Arthur, adding, “It works within minutes!”

Steve Mitchell was diagnosed with testicular cancer in 1991, at which time he was working on the West Coast. Shortly thereafter, he began undergoing chemotherapy in an effort to combat his disease, but experienced severe nausea, including dry heaves, “the likes of which are indescribable.” Mitchell described how we was in a research group for a new (at the time) anti-nausea drug called Zofran. Zofran carried a cost of $1,000 per treatment (a small IV packet).

“The more [Zofran] I took, the sicker I got. I regurgitated because I was not eating solids, couldn’t keep them down.”

Echoing Grinspoon’s observations regarding the anxiety associated with a wide range of debilitating and potentially terminal diseases, including cancer, Mitchell described how he suffered from anxiety attacks. “Another thing all this pain and suffering brings about is major anxiety attacks,” said Mitchell. “I never knew what anxiety was before this experience.”

When Mitchell and his wife considered using cannabis to relieve his symptoms, he consulted with his one dozen doctors. The most common responses, according to Mitchell? “It’s illegal.” “It’s against hospital policy.” “What would you want to do that for?” Unfortunately, even with so many medical doctors and cancer specialists at his disposal, Mitchell received no positive information or encouragement to pursue this route.

A co-worker then suggested that Mitchell consider medical cannabis. His wife obtained some and sneaked it into his hospital room, helping him smoke a joint next to an open window in his room after midnight, with towels positioned at the bottom of the closed door to prevent the smell from giving them away, like college students in a dorm hoping to avoid a strict resident advisor.

“I only took three or four hits and had immediate relief. It took away the nausea and I had an appetite.”

A nurse, made curious by Mitchell’s remarkably upbeat and energetic mood — and complete lack of nausea following the consumption of cannabis — inquired as to the source of his improvement. When informed that it was the result of smoked cannabis, the nurse responded, “Oh my God, don’t tell me that. It’s illegal! I’ll lose my job! They’ll kick you out of the hospital!”

The Best Ways to Consume

Today’s medical and recreational cannabis scene involves literally dozens of ways to consume the kind herb. Many options are available, from smoking joints and old-school bongs to high-quality desktop herb vaporizers and modern twists like dabbing concentrates in the form of BHO, wax, shatter, and live resin. But for cancer patients suffering the side effects of chemotherapy, one of which is severe nausea and vomiting, or Crohn’s patients who are experiencing severe wasting and zero appetite, what is the best way to consume cannabis?

First, as stealthy and practical as they can be, edibles are out simply because they don’t even begin to take effect for 45 minutes to two hours. Those suffering nausea and vomiting don’t have the luxury of waiting two hours for the onset of their medication. However, it is understandable that many also don’t desire to smoke. New, high-tech portable vape pens has brought vaporization out of the basement and spare bedroom of health conscious cannabis consumers and delivered it to the metro, the office smoking section, and even one’s work cube (if company policy doesn’t prohibit it).

What about those who are also suffering from respiratory conditions that don’t allow for vaping? If edibles are no good for nausea and vomiting and one also can’t smoke or vape, what’s left? Thankfully, there is a great option in the form of both tinctures and pills. Many dispensaries, especially those in more progressive legal states like California, Oregon, and Washington, sell capsules and pills that contain an accurately gauged amount of THC (or CBD, depending on need).

Both capsules/pills and tinctures allow for discreet, normalized consumption in what appears to be a conventional pharmaceutical drug. This allows patients to combat nausea when at the office, on a flight, at a restaurant, or anywhere in public. Especially for patients in prohibitionist states lacking even a valid medical cannabis program, stealth when breaking the law in an effort to curb the negative side effects of one’s life-sustaining conventional medical treatments is paramount. It is unfortunate that innocent patients who already must suffer the financial, physical, and emotional impact of their disease must also be forced to break the law by purchasing often mediocre, impure, or even contaminated medicine on the black market.

Fortunately, in the states that do have robust medical cannabis programs in place for their sick citizens, many recognize nausea, especially when induced from chemotherapy, as a valid condition.

Strains for Nausea

There are many strains of cannabis, both sativa and indica varieties, that are especially helpful for relieving nausea and alleviating vomiting and other gastrointestinal disturbances. The following are some of the more effective strains across the board of indica, sativa, and hybrid categories, but this is in no way a comprehensive list.

Platinum OG (indica): An indica-dominant hybrid that provides a comforting blanket of body relaxation while the high THC content helps reduce pain and nausea and acts as an appetite stimulant.

Northern Lights (indica): This classic strain leaves users relaxed and euphoric while relieved of stress, anxiety, and nausea. It also helps to stimulate the appetite.

Super Lemon Haze (hybrid): A sativa-dominant from South Africa that leaves users feeling energized, motivated, and clear-headed. It combats depression, fatigue, pain, and nausea, but it may not be the best choice for those suffering from anxiety.

Girl Scout Cookies (hybrid): A cross of Durban Poison and OG Kush, the cerebral effects of this strain hit hard and fast. This strain will combat stress, nausea, and pain, and has been known to stimulate the appetite. It tests high in THC and may be too intense for novice users.

Optimus Prime (indica): An indica-dominant strain that is common among patients to produce a slowly creeping buzz that covers the body in relaxation. It also aids in calming nausea, easing aches and pains, and inducing strong appetite. Can result in couchlock, especially for inexperienced users.